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Research.Pdf (5.178Mb) ‘WAITING FOR THE COLD TO END’: A QUALITATIVE EXPLORATION OF PHOTOVOICE AS A THERAPEUTIC INTERVENTION FOR SURVIVORS OF SEXUAL ASSAULT ______________________________________________ A Dissertation presented to the Faculty of the Graduate School at the University of Missouri-Columbia ________________________________________________ In Partial Fulfillment of the Requirements for the Degree Doctor of Philosophy _________________________________________________ by ABIGAIL J. ROLBIECKI May 2015 FACULTY APPROVAL The undersigned, appointed by the dean of the Graduate School, have examined the dissertation entitled ‘WAITING FOR THE COLD TO END’: A QUALITATIVE EXPLORATION OF PHOTOVOICE AS A THERAPEUTIC INTERVENTION FOR SURVIVORS OF SEXUAL ASSAULT presented by Abigail Rolbiecki, a candidate for the degree of Doctor of Philosophy, and hereby certify that, in their opinion, is worthy of acceptance. ______________________________________ Professor Kim Anderson _______________________________________ Professor David L. Albright ________________________________________ Professor Colleen Galambos _________________________________________ Professor Aaron Thompson ____________________________________________ Professor Michelle Teti This dissertation is dedicated to the nine women who bravely shared their stories with me. It took great courage to be so vulnerable, and I have no words to express my gratitude. I would like to also dedicate this dissertation to my daughter, Lennon, for she reminds me that there is goodness in the world, and provides hope for a better future for women and girls. ii ACKNOWLEDGMENTS I acknowledge with wholehearted thanks, my doctoral advisor, Dr. Kim Anderson, without whom this dissertation would have never been started, nor completed. This work is only a small representation of my graduate journey, marked by invaluable clinical and research experience. I am indebted to her, and the many other individuals involved in this process. I would like to also thank my committee for their guidance, and for helping me reach this point in my academic journey. Thank you, University of Missouri Relationship and Sexual Violence Prevention (RSVP) Center, for providing the space and time to do this important and necessary work. Lastly, I would be remiss if I did not thank my friends and family – most importantly, my wife – for their love and support throughout my graduate education, and this dissertation. I am the woman, and scholar, I am today because of these support networks. iii TABLE OF CONTENTS Acknowledgements...................................................................................................................................................ii List of Tables……………………………………………………………………………………………………...vii List of Figures………………………………………………………………………………………………..….viii Abstracts…………………………………………………………………………………………….......................ix Chapter 1……………………………………………………………………………………………………………..1 Background……………………………………………………………………………………………….1 Definition, Prevalence, and Risk Factors……………………………………………………..3 Definition……………………………………………………………………………………….3 Prevalence……………………………………………………………………………………...4 Risk Factors……………………………………………………………………………………4 Male Sex Role Socialization…………………………………………………...4 Involvement in University Greek Life…………………………………….5 Alcohol Consumption…………………………………………………………...5 Media Portrayal of Sexual Assault…………………………………………5 Bio-psycho-social Consequences of Sexual Assault……………………………………...6 Physical Consequences……………………………………………………………………6 Psychological Consequences……………………………………………………………7 Social Consequences……………………………………………………………………….8 Sexual Assault Recovery…………………………………………………………………………….8 Summary…………………………………………………………………………………………………..9 Significance of Study………………………………………………………………………………..10 Purpose of Study and Research Questions………………………………………………...10 Dissertation Overview……………………………………………………………………………..11 Chapter 2…………………………………………………………………………………………………………...12 Literature Review……………………………………………………………………………………12 Posttraumatic Stress Disorder (PTSD)…………………………………………...12 PTSD Etiology – Theoretical Assumptions……………………………………...13 Other Psychological Outcomes of Sexual Assault…………………………….15 Depression…………………………………………………………………………15 Self-blame………………………………………………………………………….16 Social Learning Theory and Trauma Response……………………………….17 Behaviorist Principles………………………………………………………...17 Cognitive Principles…………………………………………………………...22 iv Systematic Review of Evidence-Based Interventions………………………………...22 Stress Inoculation Therapy (SIT)…………………………………………………...24 Prolonged Exposure Therapy (PE)…………………………………………………25 Cognitive Processing Therapy (CPT)……………………………………………...26 Eye Movement Desensitization and Reprocessing (EMDR)……………..26 Supportive Counseling…………………………………………………………………..27 Gaps in Treatment Literature for Sexual Assault Survivors………………………..28 Posttraumatic Growth……………………………………………………………………………..29 Introduction of PhotoVoice………………………………………………………………………30 Connecting PhotoVoice to Cognitive and Behavioral Frameworks…..30 History and Purpose of PhotoVoice………………………………………………..31 Theoretical underpinnings of PhotoVoice……………………………………....32 PhotoVoice as a Therapeutic Intervention for Sexual Assault Survivors……………………………………………………………………………………...34 Meaning-making and PhotoVoice…………………………………………………..35 Narrative Theory and the PhotoVoice Process………………………………..36 Behaviorism and PhotoVoice…………………………………………………………38 Conceptual Insights…………………………………………………………………………………39 Chapter 3…………………………………………………………………………………………………………...42 Research Methods…………………………………………………………………………………...42 Participants………………………………………………………………………………….42 Informed Consent…………………………………………………………………………42 Protection of Human Subjects……………………………………………..42 Potential Risks…………………………………………………………………...42 Research Design……………………………………………………………………………43 Study Research Aims, Questions, and Hypothesis…………………………...44 Hypothesis…………………………………………………………………………44 Sampling Procedure……………………………………………………………………...44 Sample………………………………………………………………………………44 Intervention Procedure…………………………………………………………………45 Telephone Initial Inquiry…………………………………………………....45 Pre-screening…………………………………………………………………….45 Inclusion criteria………………………………………………………..………46 Orientation………………………………………………………………………...46 Focus Groups…………………………………………………………………..…47 Exhibit Planning Focus Group……………………………………………..48 PhotoVoice Exhibits……………………………………………………………49 Data Collection Procedure……………………………………………………………..50 Recruitment……………………………………………………………………….50 Data Collection Points………………………………………………………...51 Qualitative Instruments……………………………………………………………...…51 SHOWeD Instrument………………………………………………….………51 Individual Interview Instrument…………………………………………52 Quantitative Instruments………………………………………………………………52 Concept: Posttraumatic Stress Disorder………………………….…...52 v Concept: Posttraumatic Growth…………………………………………..53 Concept: Positive Rape Attributions……………………………………54 Analytical Strategy………………………………………………………………………..55 Qualitative Analytical Methods……………………………………………55 Coding……………………………………………………………….……55 Qualitative Methodological Rigor……………………………..56 Quantitative Analytical Methods…………………………………………59 Summary………………………………………………………………………………………………...59 Chapter 4…………………………………………………………………………………………………………...60 Demographics…………………………………………………………………………………………60 Qualitative Results…………………………………………………………………………………..61 Photo Taking: Exposure to Triggers……………………………………………….62 SHOWeD Discussion: Meaning Making and Reauthoring…………………67 Group Process: Relationship Building…………………………………………….77 Photo Exhibit: Consciousness Raising…………………………………………….83 Summary of Qualitative Results………………………...........………………………………..90 Quantitative Results……………………………………………...………………………………...91 Symptoms of PTSD………………………………………………………………………..91 Posttraumatic Growth…………………………………………………………………..93 Rape Attributions………………………………………………………………………….95 Summary………………………………………………………………………………………………...96 Chapter 5…………………………………………………………………………………………………………..98 Discussion………………………………………………………………………………………………98 Implications…………………………………………………………………………………………..100 Implications for Practice……………………………………………………………..100 Implications for Policy………………………………………………………………...102 Implications for Research……………………………………………………………103 Limitations……………………………………………………………………………………………104 Conclusion…………………………………………………………………………………………….105 References……………………………………………………………………………………………………….108 Appendices………………………………………………………………………………………….…………..117 Appendix A. Participant Demographics……………………………………………………...117 Appendix B. Consent Form………………………………………………………………………...121 Appendix C. Phone Interview……………………………………………………………………..126 Appendix D. Consent with Waiver of Documentation…………………………………..128 Appendix E. Phone Consent Form……………………………………………………………….131 Appendix F. Recruitment……………………………………………………………………………132 Appendix G. Individual Interview………………………………………………………………..134 Appendix H. Posttraumatic Stress Disorder Checklist for Civilians (PCL-C)…..135 Appendix. I Posttraumatic Growth Inventory (PTGI)……………………………………139 Appendix J. Rape Attribution Questionnaire (RAQ)………………………………………142 vi Appendix K. Reduced Codes………………………………………………………………………...144 Vita………………………………………………………………………………………………………………….146 vii LIST OF TABLES PAGE Table 1. Demographics of Sample………...………………………………... 61 Table 2. T-test Results Comparing Pretest and Posttest Scores of PCL-C… 93 Table 3. T-test Results Comparing Pretest and Posttest scores for Factor 1: Relating to Others…………………………………………………... 94 Table 4. T-test Results Comparing Pretest and Posttest Scores for Personal strength.………………………………………………………………. 94 Table 5. T-test Results Comparing Pretest and Posttest Scores for Behavioral Self-blame………………………………………………………………
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